Outcomes of emergency nurse-administered digital blocks in a community hospital emergency department.

INTRODUCTION: Digital blocks are traditionally performed by physicians, physician assistants, and nurse practitioners. Procedures manuals emphasize that digital blocks are usually performed by a physician or an advanced practice nurse. In our community hospital, emergency nurses have performed digital blocks according to protocol for the past 30 years without known complications or diminished patient satisfaction. The goal of this study was to validate the effectiveness, safety, and patient satisfaction of emergency nurse-administered digital block. METHODS: Retrospective and prospective study designs were used. The retrospective arm included telephone interviews of patients who received a digital block between January 2011 and April 2012. The response rate for the retrospective survey was 23% (n = 30). The prospective arm included telephone interviews of patients who received a digital block between May 2012 and October 2012. The response rate for the prospective survey was 71.7% (n = 53). Descriptive statistics and qualitative content analysis were used in the data analysis. RESULTS: Patients who received emergency nurse-administered digital blocks rated effectiveness using the pain scale (a 0 to10 scale, with 10 being the most painful), with the following results: 74.3% reported no pain; 10.5% reported a pain level of 1 out of 10; 7.9% reported a pain level of 2 out of 10; 2.6% reported a pain level of 3 out of 10; and 2.6% reported a pain level of 4 out of 10. Safety was measured by reported complications; 5.2% of patients reported the complication of persistent numbness over 24 hours that eventually resolved. The patient satisfaction rate was 92.1%; patients who reported a score of 7 out of 10 or better (on a scale of 0 to10, with 10 being highly satisfied) were classified as satisfied. DISCUSSION: Emergency nurse-administered digital blocks were found to be effective and safe and contributed to a high level of patient satisfaction.

Intracerebroventricular injection of fructose stimulates feeding in rats.

2-deoxy-D-glucose (2DG) inhibits glycolysis and stimulates food intake. Previous work suggests that fructose may attenuate the hyperglycemic and hypothermic effects of 2DG. The current study examined the effect of intracerebroventricular fructose on 2DG-induced feeding. We found that concentrated fructose injected into the cerebroventricles enhanced food intake both in the presence and absence of 2DG. On the other hand, similar concentrations of glucose suppressed 2DG-induced food intake. These data suggest differences in metabolism of glucose and fructose and may provide insight into the metabolic steps monitored by brain glucoreceptors to control food intake.